Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery.
OBJECTIVE
To evaluate the efficacy of a single shot "3-in-1" femoral nerve block for prosthetic hip surgery in association with general anaesthesia on post-operative analgesia.


METHODS
Forty patients, ASA 1 to 3, received sham block or "3-in-1" femoral nerve block, following Winnie's landmarks with a nerve stimulator, and 40 ml bupivacaine 0.5% with epinephrine were injected after induction of anaesthesia. Vecuronium, 0.1 mg.kg-1, was added after performing the block and anaesthesia was maintained with isoflurane, oxygen 40% and nitrous oxide 60%. Fentanyl, 1.5 microgram.kg-1, was administered before incision to all patients. Heart rate, blood pressure, fentanyl requirements and FETiso were measured throughout surgery. During the post-operative period, 75 mg diclofenac i.m. and/or 0.1 mg.kg-1 morphine s.c. were administered when pain score was > 3/10 and repeated when necessary. Pain scores at first analgesic intervention, at 24 hr and 48 hr as well as diclofenac and morphine requirements after surgery were recorded.


RESULTS
There was no difference in anaesthetic requirements during surgery. The time from performance of sham or "3-in-1" femoral nerve block to the first analgesic intervention (261 +/- 49 min versus 492 +/- 40 min, P < 0.05) and time from extubation to the first analgesic intervention (61 +/- 44 min vs 298 +/- 39 min, P < 0.05) were prolonged in the study group. However, pain scores and the analgesic requirements in the postoperative periods (24 and 48 hr) were similar.


CONCLUSIONS
There is a short-term benefit during the first few postoperative hours in using a single shot "3-in-1" femoral nerve block to complement general anaesthesia for elective hip surgery.
Fournier
R
R
Department of Anaesthesiology, University Hospital of Geneva, Switzerland.
Van Gessel
E
E
Gaggero
G
G
Boccovi
S
S
Forster
A
A
Gamulin
Z
Z
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D004558:Electric Stimulation; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005267:Femoral Nerve / Q000187:drug effects / Q000502:physiology; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014673:Vecuronium Bromide / Q000008:administration & dosage
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003473:Neuromuscular Nondepolarizing Agents; D014662:Vasoconstrictor Agents; D004008:Diclofenac; D009020:Morphine; D014673:Vecuronium Bromide; D007530:Isoflurane; D009609:Nitrous Oxide; D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine